Laserfiche WebLink
PERMITTEE NAMEIADDRESS (Include FacilltY Name/Lotarion if tAfferrnn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />NAME <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERI00 <br />FACILITY YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form Applovetl. <br />OMB No. 20440004 <br />L~~ <br />NOTE: Read Instructions t~efore completing this form. <br />PARAMETER QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NQ, <br />EX <br />FREOOU~ NCY <br />ANALYSIS <br />SAMPLE <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />N <br /> MEASUREME <br />T <br /> <br />~ <br />• <br />'J i' ... <br /> <br />-.. <br />.f' ._ <br /> PERMIT <br />REQUIREMENT - ~ :t• <br />... <br />.. <br />~ <br />"c-:: - - <br />• • ~' <br /> SAMPLE <br />REMENT <br />A <br /> ME <br />SU . <br />, , • <br />:- PERMIT <br />;REQUIREMENT <br />SAMPLE <br />EMENT <br />AS ~ . -7.~ R ~ as . ,. x t <br /> ME <br />UR <br />PERMIT <br />.REQUIREMENT <br />!- i`a5T Mr: :: <br />SAMPLE <br />REMENT <br />MEASU <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />EMENT <br />MEASUR <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />REMENT <br />MEASU <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />EASUREMENT <br />M <br />PERMIT <br />REQUIREMENT <br /> I rertd. °nder prnaltp gnaw mat thi. d«nmenl and ntt uluKnmrnea «eR TELEPHONE DATE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br /> <br />----- "' ~~ . prepared under mr dirrctlun or supcni.ion in accordance NitA a +)arm drsigm•tt <br />to aware that yualifted ttervmm•1 proprrl> gather and raaluute the information <br />auhmiUtd. Itawd on m) inyuin ~d the pet3ort or pawns vho manage Ihr yUem, <br />the information. the information <br />Umrin <br />ibl <br />Ga <br /> <br />i. ~!_' <br />~ -- <br /> <br />~ <br /> <br /> <br />~ <br /> <br /> <br />~L~ <br />_ <br />; g <br />r tiW <br />nr thu.a• prnnns dirrrtl. racpuns <br />r <br />d. the Ika of mp know Irdge and tKtief, true, accurace, and rnmpkle. <br />auhmittrd h <br />IGNATURE OF PRINCIPAL EXECUTIVE ~ 7 ~' 1'-- <br />• <br />` <br />•' <br />, . <br />t mn awum that tlxrc arc +ignificum prnahira for >uhmNttng rul.+r information' S <br />OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />TVDFfI r1R PRINTED ~ inctud'mg for gr.:Uhilih or tine end impriwnmem for knowing rMlutl~un. DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) .`~,F,L ~ F^. ~rih' : CtivR 124Hf7 PR~~: i P !='.'ANT - OFF I A. 2. <br />r <br />• PAGE OF <br />s=an Fnrrn 3320-1 IRev. 3/991 Previous editions may be used. ThtS -tS 1 ~=paft 1(NTlt. <br />